Factors associated with mortality in severely malnourished hospitalized children who developed septic shock

  • Visnu Pritom Chowdhury Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh https://orcid.org/0000-0003-0691-2791
  • Monira Sarmin Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
  • Mehnaz Kamal Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
  • Shafiul Islam Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
  • Mohammad Abubakar Siddik Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
  • Farzana Afroze Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
  • Muhammad Waliur Rahman Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
  • Tahmeed Ahmed Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
  • Mohammod Jobayer Chisti Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
Keywords: Septic shock, severe acute malnutrition, sepsis, malnutrition, blood transfusion

Abstract

Introduction: Septic shock can often lead to death, even in resourceful settings, if not handled carefully. Therefore, we sought to evaluate the factors associated with deaths in the context of severe malnutrition and also the effects of early, i.e., within 3 hours of diagnosing septic shock vs. late blood transfusion.

Methodology: Here, all under-five severely malnourished septic shock children were admitted to ICU during 2013-2017. Children who died constituted cases (n = 54), and the survived (n = 39) represented controls. We excluded children who received the blood transfusion for other causes and who left against medical advice.

Results: In both descriptive and multivariate analysis, we found that death was significantly associated with the use of fourth-line antibiotics, corticosteroids, and the addition of vasopressors on top of dopamine (all p < 0.05). However, the decrease of serum calcium level was found significantly associated with death only after adjusting (p < 0.05). Even though the cases more often received early blood transfusion than the controls, the difference was insignificant (p = 0.134).

Conclusions: When a severely malnourished under-five child develops septic shock, requiring vasopressors, fourth-line antibiotic, and corticosteroid, with reduced serum calcium, the probability of death increases significantly. Our findings underscore the gravity of close monitoring at these points and the niches for early interventions.

Author Biography

Visnu Pritom Chowdhury, Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh

Research fellow, Nutrition and Clinical Services Division, icddr,b

Published
2022-02-28
How to Cite
1.
Chowdhury VP, Sarmin M, Kamal M, Islam S, Siddik MA, Afroze F, Rahman MW, Ahmed T, Chisti MJ (2022) Factors associated with mortality in severely malnourished hospitalized children who developed septic shock. J Infect Dev Ctries 16:339-345. doi: 10.3855/jidc.15135
Section
Original Articles